Agenda item

-       Sharon Kemp, Chief Executive and partners to present

Sharon Kemp, Chief Executive, Chris Edwards, Rotherham Clinical Commissioning Group and Louise Barnett, The Rotherham Foundation Trust, gave the following short powerpoint presentation on Rotherham Integrated Care Partnership (Rotherham ICP) and the implementation of the Rotherham Integrated Health and Social Care Place Plan (IH&SC):-

 

Rotherham ICP Partners

-          NHS Rotherham Clinical Commissioning Group

-          Rotherham Metropolitan Borough Council

-          The Rotherham NHS Foundation Trust

-          Rotherham Doncaster and South Humber NHS Foundation Trust

-          Voluntary Action Rotherham

-          Connect Healthcare Rotherham CICI

 

Rotherham ICP Place Governance

-          Rotherham Together Partnership

-          Rotherham Health and Wellbeing Board

-          Rotherham ICP Place Board

-          Rotherham ICP Delivery Team – Children and Young People, urgent Care, Community, Learning Disability, Mental Health

 

Rotherham ICP Place Plan: ‘Plan on a Page’

-          Vision

-          Gaps

-          Challenges

-          Transformation

-          Enablers

-          Principles

-          Partners

 

Rotherham ICP Place Plan Priorities

-          Children and Young People

Implementation of Children and Young Peoples Mental Health Services Transformation Plan

Maternity and Better Birth

Oversee delivery of the 0-19 health child pathway services

Children’s Acute and Community Integration

Special Educational Needs and Disability (SEND) – Journey to Excellence

Implement ‘Signs of Safety’ for Children and Young People across partner organisations

Preparing for Adulthood (Transitions)

-          Mental Health and Learning Disability

Deliver improved outcomes and performance in the Improving Access to Psychological Therapies Service

Improve Dementia diagnosis and support

Deliver CORE 24 standards for Mental Health Liaison Services

Transform he service at Woodlands ‘Ferns’ Ward

Improve Community Crisis Response and intervention for Mental Health

Better Mental Health for All Strategy

Oversee Delivery of Learning Disability Transforming Care

Support the implementation of the ‘My Front Door’ Learning Disability Strategy

Support the development and delivery of Autism Strategy

-          Urgent and Community

Creation of an Integrated Point of Contact for Rotherham

Expansion of the Integrated Rapid Response Service

Development of an integrated Health and Social Care Team to support the discharge of people out of hospital

Implementation of integrated locality model across Rotherham

Develop a reablement and Intermediate Care offer

Develop a co-ordinated approach to care home support

 

Key Achievements

-          Urgent and Emergency Centre

Opened July 2017 delivering an innovative integrated model to improve co-ordination and delivery of urgent care provision

-          Rotherham Health Record

Enables health and care workers to access patient information to make clinical decisions

-          Delayed Transfers of Care

Successful reduction in Delayed Transfer of Care to below national target

Supported by the integration of TRFT Transfer of Care Team and RMBC Hospital Social Work Team to form the Integrated Discharge Team

-          Ferns Ward

Provides integrated specialist mental and physical health care expertise for TRFT patients who are physically well enough to be discharged from the acute setting but are not yet well enough to be discharged home or to residential care

-          Social Prescribing

Continued success, helping adults over the age of 18 with long term health conditions to improve their health and wellbeing by helping them to access community activities and services.  During 2017 it was extended to mental health patients and is now used for Autism and social isolation

 

Integrated Locality Working – how are we working differently?

-          A joint culture of prevention

-          ‘Blurring’ of professional boundaries

-          New ways of supporting Primary Care enhanced by Rotherham Health Record

-          Enhanced Social Care Assessment and Care Management

-          Proactive Primary Care Programme

-          Management of Long Term Conditions

-          Focus on the needs of physical and mental health

-          Work into hospital based services to reduce length of stay

-          Improved opportunities for post discharge follow-up

-          Re-alignment of GP practices across 7 localities

-          Community Nursing working directly into 7 localities configures around Primary Care

-          Adult Social Care and Community Health Teams (including Mental Health) working across 3 partnerships North, Central and South – aligning to 7 Primary Care Populations

 

Better Mental Health for All

-          Rotherham Five Ways to Wellbeing launched May 2018

-          International interest in the Rotherham Five Ways to Wellbeing video

(https://www.youtube.com/watch?v=jb5NqV2bqGI&feature=youtu.be)

 

Child and Adolescent Mental Health Services (CAMHS)

-          Extensive service change has led to substantial improvement in both assessment and treatment

 

Challenges and Opportunities to delivering the Place Plan

-          Resources – capacity and capability to deliver the transformation

-          Relationships – partners, public, organisational reputation, changing behaviours

-          Research – challenge of transformation, impact of national and local policy, innovations

 

What Next

-          Continue to deliver on the transformation set out in the Place Plan

-          Providers working closer together across Rotherham (Provider Alliance)

-          Explore and scope opportunities for joint workforce plans across Rotherham ICP partners

-          Continue to monitor implementation of the Place Plan through the Performance Report

 

Also attached was the ICP performance report for Quarter 1.

 

Discussion ensued on the presentation with the following issues raised/clarified:-

 

·           The minutes of the Place Board were submitted to the Health and Wellbeing Board, which also looked at broader issues including the wider determinants of health.  Winter pressures were dealt with in a system approach

 

·           The Place Board met on a monthly basis and was open to the press and public.  It was the only Board that was open to members of the public and allowed to ask questions at the beginning of the meeting.  There were at least 3-4 people who attended as well as some campaign groups 

 

·           The Memorandum of Understanding set out how the partners would work together as organisations.  It was not a legal partnership but a partnership entered into because it was known that by working together they could provide a better service to the residents of Rotherham

 

·           Rotherham Health Record – the partnership had challenged everything done and driven through the changes for the benefit of Rotherham patients.   However, there were 2 GP systems in operation in Rotherham and GPs could choose which one to operate.  Attempts were being made to promote the use of System 1 which all Community Services used

 

·           Recognition that probably achieve better out of hospital services based in the locality.  Discussions were still taking place as to the how and each locality was different.  It was hoped a model would be ready for 1^st April 2019

 

·           The CAMHS Service was much improved with access comparing favourably across South Yorkshire

 

·           TRFT was working very closely with the universities and colleges so there was an opportunity for people to enter health care, particularly in the nursing area, at any age, through any route and was a pilot organisation in terms of taking that forward.  Rotherham currently had those associate nursing colleagues within the organisation

 

·           There was some national funding available through different routes to support training and then the Trust employed people who undertook those roles so they received support both through the work place and the student experience depending upon which type of education they were undertaking.  Through the workforce plan the Trust, together with partners across South Yorkshire and more widely, could try and influence the number of places available and how that was shaped for the future

 

·           A visioning event had been held regarding the possibility of converting an old caretaker’s house within the Wingfield Ward into a nursery unit to deal with SEND/primary aged mental health problems.  Advice was now needed as to who to contact to pursue the matter

 

·           Partner organisations were working together on the Mental Health Services and currently challenging the Government about some of the funding received particularly for primary schools and secondary schools

 

·           There was recognition around closer work on Mental Health Services with schools.  If successful the Trailblazer bid would provide investment in schools which would allow big differences to be made in working in a more integrated way

 

·           Access to the CAMHS Service had increased significantly with extra capacity put into the Service.  The Service was now dealing with referrals from GP surgeries significantly better than previously although some of the pathways were still not where one would want resulting in waits for specialist areas

 

·           CORE24 would be an enhanced service based in the Urgent and Emergency Care Centre at the Hospital and implementation was a national requirement, with Rotherham one of the Trailblazer areas.  However, workforce was an issue for Rotherham and implementation had been expected this quarter but had slipped due to significant problems in recruitment of staff.  All staff were now in post and the enhanced Service would commence on 7^th January, 2019

 

·           Currently there was a 4 weeks wait from GP referral for assessment.  If there was a crisis in the intervening period the client would be referred to the Crisis Team

 

·           Clarification was sought with regard to the Crisis Services for CAMHS as opposed to Adult Services

 

·           CORE24 would be an enhanced service based in the Urgent and Emergency Care Centre at the Hospital

 

·           The jointly funded post, referred to in CH1.5, which was due to start in September 2018, was related to the Trailblazer bid the outcome of which was still awaited

 

·           Significant investment been made in NHS ICT systems over the years with still more work needed to be done for it be fully interoperable.  There was a digital plan for Rotherham and work was taking place to get the Rotherham Healthcare Record to work with the aid of innovative technology which allowed Rotherham professionals to see the record of Rotherham patients

 

·           Better Births was a requirement by 2021 for Rotherham to come up with some key requirements to transform Maternity Services.  It would have to offer 3 different types of setting for births and continuity of care for up to 50% of mothers.  Rotherham currently had a quite small home birthing service and would look to enhance it.  Nationally, data stated that approximately 10% of mums wanted to access a home birthing service and 40% of mums would wish to access a Midwifery-led Service.  The current draft plan would look to have an “alongside midwifery-led unit” based at the hospital, an environment that was midwife-led but close enough to consultants if needed, and also have a consultant-led service as there currently was.  There would be investment in the Service in the coming year to facilitate the developments.  The final plan was expected in April 2019 and could come back to HSC for feedback

 

·           As part of the South Yorkshire and Bassetlaw Integrated Care System, notification had been received of funds to help transform services over the next 3/4years.  The funding would be for the retraining of staff, recruitment of new professionals, different ways of working and resources to develop the transformation plan.  The funds would be one-off for 3 years

 

·           The Mental Health 3 KPIs that were red:-

 

Improving Access to the Psychological Therapy Service - increase the number of trained staff and performance had improved significantly – now on track in Quarter 3

Urgent Response - tied in with CORE24 development – once all the staff were in post and rolled out live it should be on track

Length of Stay on Ferns Ward – the model of Ferns was about reducing the overall hospital inpatient stay.  The target was to stay in Ferns once transferred from the Hospital Trust was taken into consideration. The evaluation had come out very positive in terms of the patient and carer experience, quality of live and living independently with supporting packages in place.  This would be taken into consideration for the new model and would be discussed with TRFT and the RCCG.  The length of stay may increase when all factors are taken into account

 

·           The recruiting of staff for Urgent Response was difficult and even more so with the extra challenge of initiatives such as CORE24 and perinatal work that required staff that had very specialised skills and everyone recruiting from a relatively small pool

 

·           There was a range of drop-in support and activities taking place in Ferns.  There was the opportunity for ex-patients to come back into the use for ongoing support

 

·           The 4 week wait from GP referral to assessment was the time contracted with RDaSH.  In Sheffield it was 6 weeks.  However there appeared to be some disconnect between the information presented and anecdotal evidence from colleagues on the ground

 

·           Rigour of the performance data:-

 

RCCG - there was a legal requirement for providers on how they recorded data and waiting times.  RCCG quoted the data they were provided with

 

TRFT - had a series of documents that specified how it should collate and capture data and well as some local data which the Trust defined for themselves and captured.  The Trust had developed an internal data quality kite mark with 6 elements that enables it to understand what the source of that information was, understand the definition, how it was pulled together and how reliable it was and presented the kite mark against each Indicator that was seen at Board level.  That gave a level of confidence as to how robust the performance information was.  The aim was to be “green” on all kite marks against every piece of data in the organisation and it was prioritised in order of importance in terms of reporting

 

RDaSH - Mental Health Services had national guidance on reporting mechanisms which stated what could be included and not and how things could be counted.  RDaSH had moved to System 1 so all the reporting was pulled out from the system and no manual collection of data, making it clearer what was recorded where and how

 

·           Concerns were raised about access to GPs, obtaining appointments and being able to address a patient’s health needs holistically and any knock on impact on the UECC

 

·           There was a national shortage of GPs.  Roughly the national average was 58 GPs per 100,000 population; Rotherham had 58.6 compared with 70 in Sheffield

 

·           Last year Rotherham was the only one to have a full GP trainee scheme in Yorkshire and Humber.  However, once trained they did not have to stay in Rotherham and could move where ever they wanted

 

·           RCCG had to carry out a national survey, Rotherham Patient Report.  Out of the 5 South Yorkshire communities Rotherham had the highest satisfaction rates.  Whilst comparing, additional GPs could not be found so the solution adopted was that of a different workforce i.e. Physio First, pharmacists in practice, Physician Associates.  It was found that fewer patients would see their GP and would try other professionals such as an Advanced Nurse Practitioner.  Primary Care was changing and it was not just GP services but the wider primary care services

 

·           GP Practices were different; some had open access/appointments/telephone triage.  One of RCCG’s solutions had been an additional 132 GP hours’ time that anyone could book into at different hubs – 3 different GPs covering Rotherham on a shift system.  It consisted of planned appointments that anyone could book into.  This had come into operation in November and was available to everyone at every practice.  People would book an appointment through their own practice

 

·           An appointment had not been made to the post of lead officer who would be responsible for the implementation of the Joint Preparation of Adulthood Action Plan.  A number of changes had been made to the method of dealings with some of the transition services both as a partnership and internally as a council.  There was now a workforce lead for the Council who was also acting as the lead across the whole Integrated Place Plan in an attempt to bring together the workforce challenges.  There was a theme across some of the red indicators of accessing staff with the right skills and availability

 

·           There were some key challenges around the workforce that would need to continue to be addressed some of which would involve doing things differently with the universities and college and being creative with the use of funding such as the apprenticeship levy

 

·           A piece of work had started with the Mental Health and Learning Disability Transformation Board looking specifically at suicide prevention and reviewing the recent cases of suicide.  Rotherham was an outlier in terms of suicide.  Training plans were in place to train front line staff

 

·           There would be a specific piece of work through the delivery group to look at some of the issues of suicide. Rotherham had been shown as an area of good practice in its suicide prevention work, however, the suicide rates were still increasing.  It was seen as a key area to examine and Public Health was very driven. Rotherham was to receive ISC funding and Housing were looking at suicide rates in Council housing.  Work was taking place on reviewing and trying to tie up the 5 Ways of Mental Wellbeing into near misses and having a much clearer pathway for organisations to look at near misses alongside involvement of GPs

 

·           The review of training requirements for care home staff to enable effective delivery of service had been led by the TRFT and Adult Services in terms of contract compliance to identify where there were issues.  It had been identified that the turnover of staff made it really challenging to retain the information given during training, so the focus would be on the individual and that the individual’s care plan was very clear about how their care and treatment was delivered.  That had shown a real difference to the sustainability of good care for that individual rather than it being about teaching staff

 

·           Clarification was sought about Rotherham Opportunity College and availability of placements

 

Resolved:-  (1)  That the general update on the Rotherham Integrated Care Partnership and Integrated Social Care Place Plan be noted.

 

(2)  That the Select Commission continue to monitor progress.

 

(3)  That when the Scorecard for Quarter 2 becomes available it be submitted to the Select Commission for further scrutiny in the Performance Sub-Group.

 

(4)  That the crisis arrangements for the CAMHS Services be clarified and reported back to the Select Commission.